DMAS Announces Enhanced Dental Benefits to Adult Members

After July 1, 2021, Optima Family Care will no longer offer enhanced dental benefits to Medicaid and FAMIS members. Beginning July 1, 2021, the Virginia Department of Medical Assistance Services (DMAS) will offer comprehensive dental services for 750,000 adult Medicaid and FAMIS members 21 and older.

Medical Necessity Criteria (MNC)

The Comprehensive Needs Assessment must document the need for crisis stabilization services. To qualify for this service, individuals must demonstrate a clinical necessity for the service arising from a condition due to an acute crisis of a psychiatric nature that puts the individual at risk of psychiatric hospitalization.

Crisis Stabilization Authorization Changes – Effective July 25, 2021: Comprehensive Needs Assessment (CNA)

The Comprehensive Needs Assessment is the initial face-to-face interaction encounter in which the provider obtains information from the individual, and parent, guardian, or other family members as appropriate about the individual’s mental health status and behaviors. The CNA serves to gather information to assess the needs, strengths, and preferences of the individual.

Is Your Provider Directory Status Current?

It is important to routinely review and update your status on the Optima Health Online Provider Directory. This ensures members know your correct status, allowing them to make the best choices for their families. You may also confirm your status by calling provider relations.

Optima Health Announces Payment Policy Changes

Optima Health wants to make you aware of changes to our provider payment policies, effective August 1, 2021.

Quarterly Newsletter Supplement: Notification of Changes for Medicaid DME Services

Optima Health has received notice from the Virginia Department of Medical Assistance Services (DMAS) of its intention to implement a rate floor for durable medical equipment (DME), orthotics, prosthetics and supplies as a result of General Assembly action item #313 MMMM (“Action Item”).